•Gastric pepsin duodenal contents exacerbate the action of acid and deleterious effect on the production of esophagitis

•Gastric pepsin duodenal contents exacerbate the action of acid and deleterious effect on the production of esophagitis

•The antireflux barriers include two " sphincter" mechanisms: the lower esophageal sphincter, and the crural diaphragm that functions as an external sphincter

Gastroesophageal reflux occurs when LES pressure is lower than the intragastric pressure such as in LES hypotension, increased frequency of transient lower esophageal sphincter relaxation (TLESR), when the intragastric pressure increases.
The severity of GERD increases progressively with reflux that is mainly in the postprandial period to that in the upright posture, to that in the supine or that is bipositional reflux. Nighttime reflux leads to severe GERD.
Hiatal hernia results from multiple mechanisms and is associated with a decreased LES pressure, decreased acid clearance, increased reflux, and more severe esophagitis

GERD symptoms-

The most common symptom of GERD is heartburn (acid indigestion). It is a burning chest pain that starts behind breastbone and moves upward to neck and throat.

Nausea
Bad breath
Trouble breathing
A hard time swallowing
Vomiting
Wearing away of tooth enamel
A lump in your throat

Risk Factors for GERD

Coughing, vomiting, straining, or sudden physical exertion can raise pressure in belly and lead to a hiatal hernia. Many otherwise healthy people ages 50 and over have a small one. Although it’s usually a condition of middle age, hiatal hernias affect people of all ages.

Being overweight or obese
Pregnancy
Delayed emptying of the stomach (gastroparesis)
Diseases of connective tissue such as rheumatoid arthritis, scleroderma, or lupus
Smoking
Certain foods and drinks, including chocolate and fatty or fried foods, coffee, and alcohol
Large meals
Eating too soon before bed
Certain medications, including aspirin

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